Glossary of Terms

Glossary of Terms


Glossary of Terms   

  • 835 File

  • Also referred to as: Electronic Remittance Advice (ERA)
  • The 835 is the electronic transaction that provides Claim Payment information which is used to auto-post Claim Payments.
  • Allowed Fee
  • This is pulled from the uploaded Allowed Fee Schedule and indicates the Payer's expected contractual amount.
  • ALWD
  • AM

  • Account Manager
  • ANSI

  • National format standard for transmitting electronic information.
  • Applied Date

  • This is the date the Applied button was used on the ERA.
  • This date may be different than the Post Date since the Post Date is driven by the Date used in the Reference Batch.
  • Beta Feature

  • The early use of a new feature that allows Users the chance to take advantage of the functionality and provide feedback before the feature's general release.
  • Bill Date

  • The most recent date that the claim was billed to the Responsible Party.
  • BWC

  • Bureau of Workers' Compensation (or WC)

  • CM

  • Days in A/R

  • Total A/R divided by the average billed amount per day over a given time period.
  • It is the number of days the average claim will remain outstanding before payment is made.
  • DB

  • Database
  • Denial

  • Denials are received from a Payer after adjudication as an explanation of non-payment.
  • On the Receipt, the Disbursed field can be used to flag items that do not belong in the System, such as, Old System Payments.
  • DOS

  • Date of Service
  • Dunning is the process of businesses communicating with customers in an effort to collect money owed for goods and/or services provided.
  • Dunning Levels are a measure of where a patient's balance is in the effort to collect the balance which drives the collection activities. 
  • When a paper or e-statement is delivered, the Dunning Level increases by 1.
  • When an acceptable payment is made, the Dunning Level decreases by 1 (or back to 0 regardless of the Level, depending on system settings). 
  • EDI

  • Electronic Data Interchange.
  • The method in which Claims, Eligibility, and Remittances are processed electronically.
  • Modify Icon  

  • The Pen and Paper Modify Icon appears throughout the System and is used to modify previous entries.
  • This icon will be referred to as the Modify icon in the documentation.
  • EFT

  • Electronic Funds Transfer
  • The Payer deposits the Payment directly into the bank instead of sending a paper check.
  • The Practice is responsible for completing the setup with each Payer.
  • We do not manage the setup for EFTs.
  • Encounter

  • A Charge that can contain multiple Dates of Service.
  • The System is an Encounter-based accounting system, which means it looks to the charge to drive a majority of the reporting.
  • EOB

  • Explanation of Benefits: This is a statement received from the Insurance Company that summarizes the cost of health care services that were received.
  • Shows how much the Provider is charging the Insurance Company, how much the Insurance is paying, and the Patient's responsibility.
  • It is not a bill.
  • ERA

  • Electronic Remittance Advice
  • An electronic Explanation of Benefits (this is not the same as an EFT).
  • Some payers require enrollment to receive electronic EOBs.
  • ERAs are used to auto apply transactions based on the file that the Payer provides us with.
  • Money that has been entered into the system on a Receipt but has not yet been applied to a service/Encounter.
  • It is used as a temporary holding place until the Payment is posted in full.
  • Etactics

  • Clearinghouse
  • Used to send, receive and process electronic Claims, Eligibility and Remittances. Enrollments for Claims, Eligibility and Remittances are handled by Etactics.
  • Etactics Output Solutions

  • Etactics Output Solutions is a Partner that is used for sending Statements and Invoices.
  • Fee Schedules

  • Charge Each DB should have one default charge fee schedule. These are the fees per CPT we send on the encounter or charge
  • Allowed: It is recommended each DB has at least the Medicare allowed fee schedule - this can be used to be sure you are being paid according to the contract you have with the payer
  • Go Cuts

  • Keyboard shortcuts to the various areas of the System.
  • Go-Live

  • Date that the Practice will begin billing Claims and partner Invoicing for the Practice’s services will begin.
  • HCFA

  • Paper Claim Form
  • Show Me How

  • Help documents, walk throughs, and videos embedded in the System.
  • IM

  • Implementation Manager (Trainer)

  • Implementation

  • The process in which a Partner or a Practice is involved in during the initial setup.
  • Libraries

  • Used as the basic building block for Claims, Statements, and Calendar setup.
  • Loaded Date

  • The date the ERA was loaded into the PM System.
  • This date may be different from the Received Date.
  • OS

  • Output Solutions (Statement Department)
  • Parse

  • To convert the imported data file into System mapped fields
  • Payer

  • Insurance Company, Attorney, Collection Agency or Third Party responsible for processing and paying Claims.
  • Payer ID

  • Most Insurance companies are able to process Claims, Eligibility and Remittances electronically.
  • The Payers have a correlating Payer ID which serves as an electronic address.
  • PM

  • Practice Management
  • Pop-up

  • A smaller screen within a larger screen.
  • These may be validation errors or warnings or a screen for entering additional information.
  • POPS (PatientOps)

  • Patient Online Payments & Scheduling (Premium add-on).
  • Online Payments are live and Scheduling is coming soon.
  • POS

  • (Place of Service) Place where the service is performed.
  • Selecting Yes for the POS Payment field allows you to track Payments that were made in the office.
  • When adding the Receipt from the Calendar, it automatically defaults to Yes, but has to be chosen when adding a Patient Payment from the other places in the System.
  • Report on POS Payments using these reports Custom Receipt Query, Payments and Adjustments Report, and Receipt Management Report.
  • Post Date

  • The Post Date is determined by the Date set in the Reference Batch.
  • It can be used to manipulate Post Dates at month end.
  • Receipt

  • The Receipt holds the details of the money received, who the Payer is, how much was deposited in the bank.
  • Received Date

  • The Received Date is entered on the Receipt or the date that auto-populates on the ERA Receipt.
  • This is the date that the Payment was received.
  • Responsibility Date

  • The date that the party became responsible for the Balance.
  • Self-Pay: The date the Charge was posted.
  • Not Self-Pay: The date the Balance was transferred to the Patient.
  •     Rejection

  • Rejections are received from the Clearinghouse or Payer before adjudication as an explanation that the Claim cannot be adjudicated as it was sent.
  • RTCS

  • Electronic Method of getting an immediate Claim Status update from the Payer.
  • RVU (Relative Value Unit)

  • RVUs define the value of a service or procedure relative to all services and procedures.
  • Site Admin

  • Each practice should have 1-2 PM Super-Users that will have all permissions and security rights in order to manage the database properly and its users.
  • Statement Department

  • Etactics Output Solutions is a Partner that is used for sending Statements and Invoices.
  • TPA

  • A Third Party Administrator is the entity responsible for the Processing and Payment of Claims for an Employer.
  • WC

  • Workers' Compensation




    • Related Articles

    • BI: Glossary of Terms

      Analysis: Authors build Dashboards in an Analysis. Author Account: Authors can build Dashboards, modify the Author-built Dashboards, and add/modify Sheets. Dashboard: Dashboards contain Sheets and Visuals that all users can interact with. System ...
    • Terms and Concepts FAQs

      Terms and Concepts FAQs Anesthesia How do I add Anesthesia Time Unit Settings? Appointments Why does the Appointment Reason not display in the Appointment Slot? Attending What is an Attending Physician? An Attending Physician is the one who is ...
    • BI: QuickSight Resources

      To access the QuickSight User Guide from the BI Tool, select the Question Mark in the upper right corner of the screen. Select Documentation in the dropdown menu. QuickSight Resources Note: This is not an exhaustive list of QuickSight resources. For ...
    • HL7 Acronyms

      Acronyms and Definitions used in the System Health Level Seven (HL7) is a set of international standards used to provide guidance when transferring and sharing healthcare data. The System uses HL7 to communicate with 3rd party vendors, and the same ...
    • FAQs Overview

      Anesthesia Billing FAQs Charge FAQs Demographic FAQs Eligibility FAQs Encounter/Visit FAQs Encounter by Status FAQs ERA FAQs Form and Superbill FAQs iDology Direct Scanning FAQs Job Scheduler FAQs Patient FAQs Payment FAQs Permission FAQs and ...